Individual provider Active NPI

Nancy Ann Wahidi, PA

  • Physician Assistant
  • Tustin, CA
National Provider Identifier
1235742420
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA58194 Issued in CA
Practice address
661 W 1St St Ste G
Tustin, CA 92780-2939
Phone
(714) 665-9890
Fax
(714) 665-9891
NPI assigned
Aug 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA58194 CA Primary

Addresses

Primary practice location

661 W 1St St Ste G
Tustin, CA 92780-2939

Mailing address

661 W 1St St Ste G
Tustin, CA 92780-2939
Phone (714) 665-9890

Other practice location 1

9918 Katella Ave Ste A-C
Anaheim, CA 92804-6465
Phone (714) 644-9494

Other practice location 2

11180 Warner Ave Ste 353
Fountain Valley, CA 92708-7516
Phone (714) 968-6789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230623002970 CA Practitioner - Physician Assistant 1759749682 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA58194CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of California Irvine CurrentSince Oct 30, 2024 Accepting new patients
Families Together of Orange County CurrentSince Jun 1, 2023 Accepting new patients
Latino Health Services Medical Group Inc PastSince Aug 1, 2020 Accepting new patients
University of California Irvine Past Accepting new patients
Families Together of Orange County PastSince Jan 21, 2024 Accepting new patients
University of California Irvine Past Accepting new patients
University of California Irvine Past Accepting new patients

Locations

300 W Carl Karcher Way
Anaheim, CA 92801
Phone (657) 282-6356

2441 W La Palma Ave
Ste 100
Anaheim, CA 92801
Phone (657) 282-6356

9918 Katella Ave
Ste Ac
Anaheim, CA 92804
Phone (714) 644-9494

11180 Warner Ave
Ste 353
Fountain Vly, CA 92708
Phone (714) 751-3540

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

200 S Manchester Ave
Ste 300
Orange, CA 92868
Phone (714) 424-9001

800 N Main St
Santa Ana, CA 92701
Phone (714) 456-6324

661 W 1st St
Ste G
Tustin, CA 92780
Phone (714) 665-9890

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1235742420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 W 1ST ST STE G",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802939",
            "telephone_number": "714-665-9890",
            "fax_number": "714-665-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 W 1ST ST STE G",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802939",
            "telephone_number": "714-665-9890",
            "fax_number": "714-665-9891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9918 Katella Ave Ste A-C",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928046465",
            "country_code": "US",
            "telephone_number": "714-644-9494",
            "fax_number": "714-644-9894",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11180 Warner Ave Ste 353",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927087516",
            "country_code": "US",
            "telephone_number": "714-968-6789",
            "fax_number": "714-202-2626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHIDI",
        "first_name": "NANCY",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.